Provider Demographics
NPI:1700942695
Name:MONICA BALI MD PC
Entity Type:Organization
Organization Name:MONICA BALI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-460-8282
Mailing Address - Street 1:13975 CONNECTICUT AVE.,
Mailing Address - Street 2:308
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906
Mailing Address - Country:US
Mailing Address - Phone:301-460-8282
Mailing Address - Fax:301-460-0851
Practice Address - Street 1:13975 CONNECTICUT AVE.,
Practice Address - Street 2:308
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906
Practice Address - Country:US
Practice Address - Phone:301-460-8282
Practice Address - Fax:301-460-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408143900Medicaid
DCG01859Medicare PIN
MDI07199Medicare UPIN